Evaluation of ICUs and weight of quality control indicators: an exploratory study based on Chinese ICU quality data from 2015 to 2020

Abstract

This study aimed to explore key quality control factors that affected the prognosis of intensive care unit (ICU) patients in Chinese mainland over six years (2015−2020). The data for this study were from 31 provincial and municipal hospitals (3425 hospital ICUs) and included 2 110 685 ICU patients, for a total of 27 607 376 ICU hospitalization days. We found that 15 initially established quality control indicators were good predictors of patient prognosis, including percentage of ICU patients out of all inpatients (%), percentage of ICU bed occupancy of total inpatient bed occupancy (%), percentage of all ICU inpatients with an APACHE II score ≥15 (%), three-hour (surviving sepsis campaign) SSC bundle compliance (%), six-hour SSC bundle compliance (%), rate of microbe detection before antibiotics (%), percentage of drug deep venous thrombosis (DVT) prophylaxis (%), percentage of unplanned endotracheal extubations (%), percentage of patients reintubated within 48 hours (%), unplanned transfers to the ICU (%), 48-h ICU readmission rate (%), ventilator associated pneumonia (VAP) (per 1000 ventilator days), catheter related blood stream infection (CRBSI) (per 1000 catheter days), catheter-associated urinary tract infections (CAUTI) (per 1000 catheter days), in-hospital mortality (%). When exploratory factor analysis was applied, the 15 indicators were divided into 6 core elements that varied in weight regarding quality evaluation: nosocomial infection management (21.35%), compliance with the Surviving Sepsis Campaign guidelines (17.97%), ICU resources (17.46%), airway management (15.53%), prevention of deep-vein thrombosis (14.07%), and severity of patient condition (13.61%). Based on the different weights of the core elements associated with the 15 indicators, we developed an integrated quality scoring system defined as F score=21.35%×nosocomial infection management + 17.97%×compliance with SSC guidelines + 17.46%×ICU resources + 15.53%×airway management + 14.07%×DVT prevention + 13.61%×severity of patient condition. This evidence-based quality scoring system will help in assessing the key elements of quality management and establish a foundation for further optimization of the quality control indicator system.

Keywords

critical care medicine / quality control / evaluation / exploratory factor analysis (EFA) model

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Acknowledgments

This study was supported by the National Key R&D Program of China (No. 2020YFC0861000), the CAMS Innovation Fund for Medical Sciences (CIFMS) (No. 2020-I2 M-CoV19-001), the China International Medical Exchange Foundation Special Fund for Young and Middle-aged Medical Research (No. Z-2018-35-1902), 2020 CMB Open Competition Program (No. 20-381), CAMS Endowment Fund (No. 2021-CAMS-JZ004), the Chinese Medical Information and Big Data Association (CHMIA) Special Fund for Emergency Project, and Beijing Municipal Natural Science Foundation (M21019), and the CAMS Endowment Fund (No. 2021-CAMS-JZ004).

Compliance with ethics guidelines

Longxiang Su, Xudong Ma, Sifa Gao, Zhi Yin, Yujie Chen, Wenhu Wang, Huaiwu He, Wei Du, Yaoda Hu, Dandan Ma, Feng Zhang, Wen Zhu, Xiaoyang Meng, Guoqiang Sun, Lian Ma, Huizhen Jiang, Guangliang Shan, Dawei Liu, Xiang Zhou and on behalf of China-NCCQC declare that they have no conflicts of interest. This article does not contain any studies with human or animal subjects.

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